Risk of death without appropriate defibrillator shock in patients with advanced renal dysfunction

Area of Science:

• Cardiology
• Nephrology
• Medical Devices

Background:

• Heart failure patients with advanced chronic kidney disease (CKD) face increased non-arrhythmic mortality.
• Comorbidities in advanced CKD contribute to higher mortality risks.

Purpose of the Study:

• To evaluate the risk of mortality without appropriate implantable cardioverter-defibrillator (ICD) shocks in heart failure patients with advanced CKD.
• To assess the impact of advanced CKD on ICD therapy outcomes.

Main Methods:

• A prospective study of 3542 patients receiving ICDs, categorized by advanced CKD (eGFR <30 mL/min/1.73 m² or dialysis) versus non-advanced CKD.
• Kaplan-Meier survival analysis and multivariate analysis were used to determine the primary endpoint: death without appropriate ICD shock.

Main Results:

• At 5 years, 46% of advanced CKD patients died without an appropriate ICD shock, compared to 19% in the non-advanced CKD group (P < 0.001).
• Advanced CKD patients had a 2.5-fold higher risk of death without ICD shock (P < 0.001).
• Appropriate ICD shock rates were low (9%) in advanced CKD patients, with a high subsequent mortality rate (63% within 3.5 years).

Conclusions:

• Nearly half of patients with advanced CKD receiving an ICD die within 5 years without experiencing an appropriate ICD shock.
• These findings highlight the critical need for careful patient selection for primary ICD implantation in the advanced CKD population.